Obstructive Sleep Apnea (OSA) is a sleep-related breathing disorder that is growing in prevalence and is associated with negative cardiovascular consequences and adverse events from excessive daytime sleepiness. Insomnia is a frequently co-occurring sleep disorder that adds significant morbidity and is a potential barrier to adherence of OSA treatment. It is currently unknown if directly treating insomnia can enhance outcomes of OSA treatment. The purpose of this project is to determine the efficacy of a multidisciplinary treatment model for patients with OSA and comorbid insomnia. At the Rush Sleep Disorders Center, we have developed an approach that combines cognitive-behavior therapy (CBT) for insomnia delivered by a psychologist with Continuous Positive Airway Pressure (CPAP) therapy managed by a physician. Building upon preliminary data collected in our clinic, we seek to test the efficacy and mechanisms of this multidisciplinary model against the standard practice of treating OSA using CPAP alone.
The specific aims are: 1) to determine the efficacy of a treatment model combining CBT and CPAP for individuals with OSA and comorbid insomnia;2) to determine if there are relative benefits in the sequence of treatment initiation;and 3) to examine the mechanisms between insomnia symptoms and CPAP adherence. To carry out these aims, a three-arm randomized controlled trial will be used to compare three treatment models: A) CBT followed by CPAP;B) CBT and CPAP concurrently;and C) CPAP alone. The desired outcome of this project is to identify the optimal treatment model and to determine if there is a causal link between insomnia symptoms and CPAP adherence.

Public Health Relevance

The purpose of this research project is to determine the impact of a multidisciplinary treatment model for patients with Obstructive Sleep Apnea and comorbid insomnia. The findings will help to identify the optimal treatment model that can improve patient care for these individuals.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
Project #
Application #
Study Section
Behavioral Medicine, Interventions and Outcomes Study Section (BMIO)
Program Officer
Laposky, Aaron D
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Rush University Medical Center
Other Clinical Sciences
Schools of Medicine
United States
Zip Code
Crawford, Megan R; Turner, Arlener D; Wyatt, James K et al. (2016) Evaluating the treatment of obstructive sleep apnea comorbid with insomnia disorder using an incomplete factorial design. Contemp Clin Trials 47:146-52
Crawford, Megan R; Ong, Jason C (2015) There are two sides to every question: exploring the construct of sleep quality. J Clin Psychiatry 76:e822-3
Ong, Jason C; Crawford, Megan R (2013) Insomnia and Obstructive Sleep Apnea. Sleep Med Clin 8:389-398
Ong, Jason C; Crisostomo, M Isabel (2013) The more the merrier? Working towards multidisciplinary management of obstructive sleep apnea and comorbid insomnia. J Clin Psychol 69:1066-77